Interview with Laurie Ayers, LAc (UK)

I’m happy to welcome Laurie Ayers to the Deepest Health podcast. Laurie is a rising star in the field of Chinese medicine whom I met through his involvement with the Institute of Classics in East Asian Medicine (ICEAM). He is someone who consistently inspires me to be a better student, and has helped me unlock more than one difficult case. Also, as a Chinese medicine practitioner in the United Kingdom, he has a few interesting notes to share with those of us who practice elsewhere. Learning about the differences in how this medicine is practiced in various countries is always illuminating.

In the podcast, we discuss a lot of topics related to the study of Chinese medicine. We focus particularly on the purpose of memorization, as well as digging into how everyday practitioners and students can make real study a way of life. Enjoy!

If you would like to find Laurie online, use the links below:

Laurie Ayers at Eastern Healing Arts
Laurie Ayers at ICEAM Instructors page

Related posts:

1. Deepest Health Podcast 7 – Clinical confidence and memorization
2. Deepest Health Podcast 11 – Interview with Dr. Arnaud Versluys (Part 1 of 3)
3. Deepest Health Podcast 1 – Lessons learned in Chinese medicine clinic

This is an old article I touched up and re-released.  I hope you enjoy it!

Guizhi – Cinnamon twig – Emperor of Emperors 

In my opinion, there is no more important herb in the materia medica than Guizhi.  It is used in so many formulas, spanning all organ systems and the vastest number of pathologies of any herb (save, maybe, Gancao/licorice).  It is fortunately also still quite affordable, and not yet being considered for banning by the FDA.  :)

The plant

• Latin name/Pharmaceutical name: Cinnamomum cassia/Cinnamomi Ramulus
• Other common names: Cassia, Chinese Cinnamon.  Note well that the cinnamon we use in Chinese medicine is NOT the same species as normal, culinary cinnamon.  I think you could probably use culinary cinnamon in a Chinese herbal formula in a pinch, but it wouldn’t be the same.
• The growing plant: As I have never seen the growing plant, I’m going to have to outsource the physical description of the plant to someone better qualified – see Ms. Grieve on Cassia.  Looking at pictures, I am impressed by the plant’s stature (it is a tree, you know).  The leaves strike a dashing profile, with strong parallel veining and a robust texture.
• The dried herb: I’ve seen a few different forms – but the most common looks as if it is cut on a diagonal – it typically includes the bark even though some sources indicate all but the very thinnest bark should be removed.
• Bensky’s Materia Medica indicates that one should look for “young twigs without leaves or any withered parts.” From what I understand the thinner the twig, the better.
• Common preparations:Many different parts of the Cinnamon plant are used, including the bark (Rou Gui) and twigs with bark removed (Gui Zhi Mu). As far as preparation goes, I could only find common use of honey-fried Gui Zhi – the addition of heat and honey increases the warming capacity of Gui Zhi but impedes its ability to release the exterior. Bensky lists dry frying as another preparation but that does not seem to be widely employed.

Chinese medicine properties

Gui Zhi is listed in the category of herbs called “herbs that release the exterior.” The most common way of thinking about this category is by relating them to the Western concept of diaphoresis. However, herbs that release the exterior are capable of much more than just promoting a sweat. In contemporary literature, Gui Zhi is considered to be warm in nature and both sweet and pungent in nature. It is said to enter the Heart, Lung and Bladder channels. In the Shen Nong Ben Cao Jing, Gui Zhi is said only to be warm in nature and pungent in flavor – omitting the sweet flavor.

This is common, the adding of a flavor in contemporary understanding of an herb.  It is a helpful memory aid for students, but I’m not sure it actually adds anything to our understanding of the herb.

It is interesting to note how the doctrine of signatures works in evaluating this herb. Compared to another part of the Cinnamon tree – Rou Gui or Cinnamon Bark – Cinnamon twig is relatively superficial, light and outward spreading. Rou Gui is closer to the heart of the tree, more protective and heavier.

Historical-cultural information about Gui Zhi

Classical text descriptions: As already discussed above, the Shen Nong Ben Cao Jing (SNBCJ) describes Gui Zhi as being pungent in flavor and warm in nature. Another interesting thing in the SNBCJ – Gui Zhi is said to be good for counterflow Qi (vomiting, hiccough, etc) and situations where the Qi or breath are “bound up” and unable to move freely. Both of these are cases of fouled up movement – in the first, the movement is going in the wrong direction and in the second, the movement isn’t happening. This may relate to the pungency of Gui Zhi – it is capable of righting wrong movement and getting things moving that are stuck.

Etymology of the characters: Let’s look at the characters for Gui Zhi again – 桂枝. The left character, guì, refers to the tree itself and doesn’t seem to be particularly interesting. However, the right hand part of that character – the 圭 – is both the phonetic but is also used to refer to a kind of jade tablet used by rulers as a symbol of their power.

Medical applications of Gui Zhi

Common uses of Gui Zhi: This is one of the rare cases where TCM usage of the herb approximates what Classical texts indicate. Gui Zhi is often used in what TCM calls “deficient wind-cold attacks” which are, essentially, externally contracted illnesses (colds, flus) that involve sweating without provocation. Gui Zhi’s pungency and similar appearance to the energetic channels of the body also make it a prime candidate for use in unobstructing blocked channels as in Bi syndromes (bad pain in the body as one finds in arthritis and similar conditions).

There are several other uses ranging from rectifying Heart Yang deficiency (with attendant palpitations and shortness of breath) to warming and tonifying the center to rectify deficiency cold of the Middle Jiao (with attendant diarrhea and noisy bowels.)

Shang Han Lun: In the Shang Han Lun we find support for the TCM notion that Gui Zhi (in the formula Gui Zhi Tang) should be used in cases where a pathogen has invaded and the balance between Ying and Wei has been disturbed, producing sweat where there should be none. Where TCM calls this “deficient wind attack” the Shang Han puts it in the category of Tai Yang disease.

Other Classical Texts: I’ve talked a lot in the last year about the classical text called the Tang Ye Jing (汤液经).  In this mostly lost text, the five elements are used in a theory of “mutual containment” in this text. Regarding Gui Zhi, it is said to be the “wood herb of the wood class.” It exemplifies wood energy in its pungency – mimicking the outward spreading nature of living wood as we know it.

Related posts:

1. The qualities and uses of the Chinese herb Mahuang / 麻黃 / ephedra
2. An Exploration into Chinese herb flavor combinations – continued!
3. An exploration into Chinese herb flavor combinations – the final chapter

Established readers : this is one of many reposted articles you will see in the coming months.  It is part of the redesign process.  I hope you agree that all of these articles are worth another look!

The topic of the Six Conformations is huge.  So huge, it’s a bit intimidating to write about.  If you’re here without much knowledge of the Six Conformations I hope that this, and related posts, will help broaden your understanding. If you’re here with lots of knowledge of the Six Conformations, I hope you will share your wisdom with us in the comments.

The Six Conformation system is another on par with the Five Elemental Phases. It is a way to sort the macrocosm and microcosm into manageable chunks that have meaningful relationships with one another.  Remember, in Chinese medicine we see the macrocosm and microcosm as completely linked. What happens in one impacts the other, and vice versa.  Holism!

In heaven (macrocosm), the six conformations are weather patterns – or atmospheric Qi. In the human being (microcosm), the six conformations exist as associated parts of the body, mind and spirit.   This is important – and complicated.  When people hear about the six conformations, they often think only about the channel system.  So, when I say Taiyin, folks automatically think, “Spleen and Lung channels.” This is erroneous thinking, even though many influential books translate Liu Jing as “Six Channels.”

Just as the Five Elemental Phases don’t refer only to organs or layers of the body, but include those; the Six Conformations don’t refer only to channels or even their paired organs, but include those.

Let’s get the nitty gritty details out of the way. What are the Six Conformations?

• Taiyang – 太陽 – Great Yang – associated with the Bladder and Small Intestine organ systems
• Yangming - 陽明 - Yang Brightness – associated with  Large Intestine and Stomach organ systems
• Shaoyang – 少陽 - Lesser Yang – associated with the Gallbladder and Triple Burner organ systems
• Taiyin – 太陰 - Great Yin – associated with the Lung and Spleen organ systems
• Shaoyin - 少陰 - Lesser Yin – associated with the Heart and Kidney organ systems
• Jueyin – 厥陰 - Reverting Yin – associated with the Pericardium and Liver organ systems

There’s a lot of layers of information associated with each of these categories.  I couldn’t hope to look at all of it in one blog post.  Let’s look at the most basic layers.

Climactic factors (for better or for worse)

The Six Conformations are related to Six climactic factors/Qi (Liu Qi).  These should be in balance in nature, but when they are out of balance we know them as the Six Evils.

• Taiyang – Cold :  associated with water, contracting quality
• Yangming – Dryness : associated with metal, dessicating quality
• Shaoyang – Fire : associated with fire, flaring/ministerial in quality
• Taiyin – Damp : associated with earth, sticky and heavy in quality
• Shaoyin – Heat : associated with fire,
• Jueyin – Wind : associated with wood, wandering in quality

As I said above, people often think Six Conformations = Six Channels.  Me, I have the opposite problem — I have it so embedded in my head that the Six Conformations = Six Channels = Six Qi (atmospheric and evil) that sometimes I become a bit confused by it.  My understanding so far is simple — when we talk about the Six Conformations out of context (as we are now) the concept includes shades of all these meanings (Qi/climactic factors, Jing/channels, layers of the body, etc) and much more.  When we are looking at a Conformation more specifically as in a disease, we can tease out what piece of information is most relevant for us at the time.  I hope this is clear.

The order of the conformations and the layers of the body

The specific order I keep using as I list the conformations is not without reason.  While there is some discussion about the placement of Yangming, most of my teachers seem to agree on this order.

Taiyang is the most outward of the conformations.  It governs the most superficial layers of the body and is associated with the Weiqi or defensive force of the human being.  Think of the premiere formulas associated with Taiyang – Gui Zhi Tang and Ma Huang Tang.  Both strongly resolve the surface.  Yangming is the next layer deep – both in some sense physically and also in terms of how external pathogens must progress in their quest to do harm.  It is in the Yangming stage that we get great fevers, this is a storehouse of immense Qi and Blood force in the average person.  Think how well this resonates with the Stomach and Large Intestine organ systems, both deep dealers in the most basic, primal functions of life.  The last Yang conformation, and thus the last protector against a disease becoming deeply internalized, is Shaoyang.  Shaoyang is said to “pivot” (a long discussion) between internal and external, and thus has a kind of oscillating quality.

Now we enter the interior of the body, going ever deeper.  Taiyin is the first of the Yin conformations and in some way exemplifies a kind of “doing without doing” — the most active of the passive organ systems.  Going a layer deeper we find Shaoyin, the north and south poles of the body – Heart and Kidney, the basic axis of the functioning of the human body.  When external pathogens reach this deeply, serious disease is the result.  Finally, Jueyin – the deepest, but also the possibility of rebirth into the Taiyang conformations in the classic cyclic manner of Chinese philosophical systems.  Jueyin is deeply involved with blood, as can be seen clearly in its encompassing of both Liver and Pericardium.

Pairing of the organ systems : insight into pathology

The more I write about this, the more I find to write.  For now, I’ll just mention one quick thing.  The conformations can be paired in the following way:

• Taiyang – Shaoyin : BL/SI with KD/HT
• Yangming – Taiyin : ST/LI with SP/LU
• Shaoyang – Jueyin : GB/TB with LR/PC

Anyone can see the wisdom of these pairings – reuniting the five elementally associated organ pairs.  We have been taught that these are pairings of mutual support.  Taiyang is supported by Shaoyin, and Shaoyin feeds Taiyang.  Thus, when you have a disease in one, the other is somehow involved.  There are particular ways that we have learned to understand this system of differentiation.  But a simple thing to consider is this — take one manifestation of Yangming disease, serious constipation.  What happens if one over purges in Yangming disease and why?  It’s easy enough to say that overpurging (using cold and bitter materials) will cause damage to the Spleen that can manifest itself in a variety of ways, including as diarrhea.  Why is that?

One way to explain it is to consider that Taiyin is the support of Yangming, so that when you overtax Yangming it will draw energy from Taiyin, ultimately depleting it.  Of course, there are people who would explain this in a much more nuanced way but when I’ve mentioned it to others they seem to understand.  Hopefully it will be helpful to you.